Questions arise for insured in Nevada

Eric Leake

Thursday, March 6, 2003 | 11:36 a.m.

Nevadans remain among the most uninsured in the country, according to two new reports that say the state's residents are among Americans most likely to have no health coverage.

Roughly 607,000 Nevadans under the age of 65 -- 31.9 percent of that population -- went without health insurance for at least part of 2002, according to a survey done by the consumer advocacy group Families USA for the Robert Wood Johnson Foundation.

Nevada was higher than the national average and ranked 11th in the nation for those without health insurance.

"I find the numbers somewhat shocking," said Mike Walsh, acting chief executive of University Medical Center, the publicly owned hospital that provides health care to many of the indigent. Though the number was surprising, Walsh noted that with 6,000 people moving to Las Vegas a month, the trend is to be expected.

"It's always been a problem in Nevada," he said.

UNLV economist Keith Schwer agreed. "People are in transition going from one job to the next or one community to the next," he said. "In that transient mode people are more likely to be without coverage."

A state study done for Great Basin Primary Care of Carson City, though calculated differently, also showed Nevada residents more likely than the average American to be uninsured.

It found 15.8 percent of the state's residents of all ages were uninsured on July 1, 2002. That is better than the previous five years but still well above the national average of about 12 percent, the group's Executive Director Roger Volker said.

"We're in the top percentile in uninsured and we're in the bottom percentile in community health centers," Volker said. "That's a real problem for us and we need to close that gap."

The state study takes a snapshot of the uninsured to better compare the trends year to year, Volker said. It showed that last July 346,000 Nevadans were without insurance, compared with 374,000 the previous July.

The sluggish economy and rising health costs combine to prompt businesses to cut back coverage or charge their workers more for it, and states are trimming their programs for poor and low-income residents, the reports said. As a result, the ranks of the uninsured now cut deeper into the middle class, according to the reports.

In Nevada affordability and a burgeoning Hispanic population that tends to be uninsured compound the problem, said Volker, who assisted with the state report.

"About 90 percent of all the businesses in Nevada are small firms and they can't really afford to provide health insurance for their employees," Volker said. "We think of ourselves as having all these large firms, but most of our businesses are actually small."

When insurance is offered, many people cannot afford to insure themselves and their families.

"It becomes pretty much unaffordable for people who are making the prevailing wage in Nevada," Volker said. "People who are coming to our state tend to be of less means."

The working poor present the greatest challenge, especially when faced with a catastrophic illness, Walsh said. The state requires the uninsured receive a 30 percent discount on bills, but it's not enough.

"If someone is making $12 an hour and gets a bill for $20,000, even with a discount it's $14,000," he said. "Nobody has come up with a solution to that problem."

The studies -- released to coincide with Cover the Uninsured Week, which begins Monday -- have local officials concerned and a national coalition looking to Congress to address the situation.

For years, Congress has stalled on how to solve the problem, said advocates who hope to change that.

"I think that there's more and more interest as the problem gets larger and larger," said Sen. John Breaux, D-La., who is proposing a major overhaul of the health insurance system.

Breaux wants everyone -- including workers, the elderly, the poor and veterans -- to get insurance from a central system, with subsidies for those who need help paying premiums.

Others have more modest plans. Some want to expand the children's health insurance program -- in Nevada it operates as Nevada CheckUp -- which offers subsidized coverage for more than 5 million kids in low-income, working families. Some, including President Bush, want to give people tax credits to help people pay for insurance they purchase on their own.

With little consensus about which approach is best, lawmakers have done nothing to alleviate the problem since 1997, when they created the children's insurance program.

Much of the improvement in the state figures was attributed to Nevada CheckUp.

Volker said that although Nevada CheckUp has increased enrollment to 25,000, personal and social costs remain for the many Nevadans who are uninsured.

"When you think of a child who has tooth pain because they cannot afford to go to the dentist, they're not learning much in school. What's going to be the outcome of that?" Volker said.

Volker said that Nevada also lags in the number of health centers to catch people who fall through the insurance cracks, with 16 such centers compared to 90 in Arizona, which has about twice the population.

D. Taylor, Culinary Union secretary treasurer, says that Nevada's problem is not unemployment. He says private industry is forcing taxpayers to pick up their uninsured slack.

"Right now they're going to end up using public health sometime. It means you and I will pay for the health care rather than the business who employs them," Taylor said. "I don't see why you and I should have to pay for the health care of somebody that works at Wal-Mart."

Through a joint account with its casino partners, the Culinary Union provides health insurance for a total of 120,000 union and family members.

"I think the casino industry has shown you can be profitable and offer people health insurance," Taylor said.

"We've had this position that companies just coming into the community with jobs are good. If they're not good jobs with benefits, they're a strain on the community."

Roughly 75 million Americans lacked health care at some point during the past two years, the reports said. The elderly are covered by Medicare.

Ninety percent of them were uninsured for at least three months, and about 80 percent were in working families.

Studies have repeatedly found that people without insurance are less likely to see doctors and more likely to be diagnosed with illnesses late.

"When people do not have health insurance, they either go without, or when they use the health care system they use the most expensive, which is to go to the emergency room," economist Schwer said.